Perioral dermatitis
What is perioral dermatitis?
Perioral dermatitis is red bumps and/or small pimples around the mouth and sometimes around the nose or eyes (also called periorificial dermatitis). We are not sure why people get perioral dermatitis. Sometimes we never figure out why, but it is often associated with the use of steroid creams or inhaled steroids (like asthma inhalers or nasal sprays for allergies). It has also been linked with toothpaste with fluorine or hormonal changes like pregnancy and birth control pills. It differs from acne or rosacea, but treatments can be similar.
How do I treat perioral dermatitis?
Most people with perioral dermatitis need a topical antibacterial cream and/or wash and there are a few options – but it will take at least 3 weeks to improve with daily use. While waiting for these to start working, use Clinique’s Redness Solutions base to cover the redness.
Azelaic acid is helpful, and it is safe for pregnant women. This can be combined with niacinamide.
Sulfur is an excellent anti-inflammatory (anti-redness) product. It comes as a bar soap (wash), gel, or mask. It comes in higher percentages (10%) and lower percentages (3%). Sulfur smells like rotten eggs, but the smell is often masked in the products and doesn’t stay on your skin. See instructions for the wash below.
Benzoyl peroxide is effective and easy to find. I prefer a liquid wash to use in the shower. Higher percent products (10%) dry you out more without extra benefit, so stay below 5% benzoyl peroxide. My favorite option is CeraVe Acne Foaming Cream Cleanser (4% benzoyl peroxide). I also like AcneFree’s 2.5% wash. See instructions for the wash below.
After you use one of the above products always MOISTURIZE! You can apply lots of CeraVe moisturizing cream at least twice a day to fight the dryness on your face.
Some have found Adapalene gel (Differin, Effaclar, AcneFree, ProActiv) helpful – this needed a prescription 10 years ago but is now over-the-counter. Use it at bedtime. See instructions below.
Steps for using a medicated wash:
Once you get into the shower, rinse your face.
Apply the sulfur wash or benzoyl peroxide wash and leave it on for at least 5-10 minutes for the medication to soak into your skin before rinsing off.
Sulfur wash or benzoyl peroxide wash can be used once or twice a day as your face wash. You do not need another face wash. Avoid exfoliating face washes.
NOTE: Benzoyl peroxide will dry you out. Apply lots of moisturizing cream to fight the dryness. Also, benzoyl peroxide can bleach towels and clothing.
At bedtime, dab the adapalene gel on the outside of your face (forehead, sideburns, chin). Massage it into the outside of your face first. Then, with the tiny bit left on your fingers, massage it over and around the nose, cheeks, and lips (these are more sensitive areas to peeling and redness).
NOTE: This will dry you out. It dries everyone out! The goal is to minimize the red and flaky skin until your skin gets used to the adapalene after a few weeks.
Right after the adapalene gel goes on, apply a lot of moisturizing cream or ointment. My favorites are CeraVe cream, Vanicream cream, or straight Vaseline (#SlugLife). You can put a thick layer of cream on because it is bedtime. It will soak into your skin more while you sleep.
NOTE: It takes a month to see results, so you have to stick with it for at least 30 days! As a side benefit, adapalene is in the retinoid family, which are the best anti-aging ingredients.
My face is peeling with adapalene. What do I do?
This is very common. Many people tell me that their skin is too sensitive for adapalene or that it made their skin peel. The real problem is that the right way to use adapalene is NOT how we naturally want to use it. Most people use too much adapalene or only put it on a few problem areas on their face.
Adapalene helps new skin grow more evenly so you have fewer newer spots, AND it takes a full month for your skin to grow out from the base layer, so it takes a full month to start seeing the results.
The problem is that adapalene starts drying out the skin and making it red right away, and you have to deal with this for a full month before you see any benefits. This first month is when most people give up and tell me that adapalene doesn’t work for them.
TIPS for proper adapalene use:
Don’t use too much. A pea-sized amount is enough for the whole face. Follow the steps above.
Start on the outside of your face, not the center. If your skin is peeling at your hairline, it is much less bothersome than around your nose and lips.
Moisturize! You cannot over-moisturize. You are trying to fight the dryness and peeling until your skin gets used to the adapalene.
Stick with it! You need to do this every night for a month to see the benefits. And the benefits are great! It shrinks your pores, makes acne better, and helps with aging!
If you can’t do every night, then apply it every other night, just be consistent!
What if my perioral dermatitis isn’t getting better?
Usually, the steps above can help most people get their perioral dermatitis better. Sometimes prescription creams or pills are needed. If over-the-counter options are not working, look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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